Staying Healthy After a Stroke

How To Prevent Another Stroke or Heart Attack

Among patients who have had an ischemic stroke, about 25% (one in four patients), will have another stroke or a heart attack within four years. A major goal of medical care for stroke patients, therefore, is to prevent these events from happening.

The good news is that you and your physician can reduce your risk for another stroke or heart attack by treating your risk factors for stroke and vascular disease. This can be done through lifestyle changes and medical treatment.

Here are the best ways to reduce the chance of having another stroke or heart attack after an initial ischemic stroke:

High blood pressure is defined as a systolic pressure (upper number) of > 140 or a diastolic pressure (lower number) of > 90. Current guidelines recommend that all stroke patients achieve blood pressures below these limits. For some patients, blood pressure may need to be even lower. Reducing your blood pressure can dramatically reduce the risk of stroke. A good rule of thumb is that for every 10 points you lower your systolic pressure (upper number), you lower your risk of stroke by a third.

You can lower your blood pressure with diet, weight loss and exercise. A modest weight loss of 10 pounds can have a positive effect on lowering your blood pressure. If you have high blood pressure, your doctor will probably prescribe medications.

Smoking is the most common cause of preventable death in the United States. Smoking also increases your risk for heart attack, stroke, lung cancer, and breathing disorders. If you stop smoking, benefits are seen almost immediately and you will be less likely to have another stroke or heart attack. Quitting is not easy, but it will be very worthwhile. Your doctor may assist you with advice on ways to quit smoking. Don't get discouraged. You can do it!

Obesity and excess weight may increase your risk of stroke, heart attack, diabetes, high cholesterol and cancer. Your physician can provide the normal weight range for your height and body type. A modest weight loss of even10 pounds can have a healthy effect on your body.

Being overweight results from eating more calories than you burn. To lose weight, you need to eat fewer calories, exercise more or both.

The American Heart Association has made the following recommendations to reduce the risk for stroke and heart disease:

  • Keep your intake of fat low
  • Eat plenty of fiber (5 - 9 helpings of fruit and vegetables daily)
  • Eat fish regularly
  • Be careful not to consume more calories than you need
  • Avoid heavy alcohol use (more than 2 drinks per day)
  • If you have high blood pressure, limit your salt intake to < 2 grams (2000 milligrams) daily

Adopting this eating plan will help you to maintain or even lose weight.

Elevated blood levels of total cholesterol and LDL (bad) cholesterol are risk factors for stroke and heart attack.

Current guidelines recommend total cholesterol of < 200, and LDL < 100 for all patients with coronary artery disease and most patients with stroke. To lower cholesterol, the right diet is important. You should also exercise daily.

Most patients with high cholesterol are treated with medications called "statins." Stroke patients with normal cholesterol may also benefit from statin therapy.

The risk of stroke is lower for people who exercise compared to people who are not physically active. Regular exercise can raise HDL (good) cholesterol and can prevent or improve high blood pressure, diabetes, and obesity. It can also help in recovery from stroke. If you are planning to significantly increase your exercise program, check with your doctor first.

Physical activity, such as walking, running, biking, swimming 20-30 minutes a day, is recommended 5 times a week. Often people are able to incorporate physical activity into their daily lives. This can be done by taking stairs instead of riding elevators, walking whenever possible, gardening and playing with your children or grandchildren.

Even people confined to a wheelchair or bed can increase their physical activity. A physical therapist may work with your doctor to help plan a program of physical activity that works for you.

Blood thinners can reduce your risk of another stroke. The most common blood thinner prescribed is aspirin, but some patients are unable to take aspirin because of an allergy or stomach problem. Aspirin reduces the formation of blood clots. Other medications are available that also prevent clots. These include Aggrenox, Plavix or Coumadin (warfarin). Your personal physician will recommend the blood thinning medication that is right for you. You may even be placed on two different medications in combination.

  • Atrial Fibrillation
    Atrial fibrillation is a disturbance in the rhythm of your heart. The heart beats irregularly. In atrial fibrillation, the heart's upper chambers (atria) wriggle instead of beating regularly. Blood isn't pumped completely out of these chambers when the heart beats, so the blood pools and clots can form. If a clot breaks off, it can flow through the blood vessels to the brain. In the brain, it can lodge in an artery leading to the brain, causing a stroke. To prevent strokes from this mechanism, most patients with atrial fibrillation should be on a blood thinner called Coumadin (Warfarin). Your doctor may also recommend other treatments.

  • Carotid Stenosis
    The carotid arteries are the blood vessels on each side of your neck that supply blood to the front and sides of your brain. Fatty deposits (plaque) from atherosclerosis may cause narrowing (also called stenosis) of these blood vessels. The blood flow to the brain may be reduced or blocked, leading to a stroke. Narrowing of the carotid artery may require an operation called carotid endarterectomy to remove the plaque build-up. This can reduce stroke risk for selected patients. Your personal doctor will be able to tell you if this treatment is right for you. Some patients with carotid stenosis may be treated with angioplasty (a balloon used to open the artery) and a stent (a device to help keep the artery open).

Every stroke patient should see a personal physician regularly for help in managing blood pressure, weight, cholesterol and other stroke risk factors or treatments. Often, this physician is an internist, family practitioner or neurologist. Your primary physician can inform you as new therapies become available and can help you achieve your personal goals for stroke prevention. Additionally, your local IRIS investigator may have additional recommendations for therapies available at your medical center.